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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Kanury Rao of International Centre for Genetic Engineering and Biotechnology in India is testing small molecule inhibitors of host proteins required for M. tuberculosis to survive and replicate within host cells. Identifying and optimizing compounds that target host proteins could lead to new drug therapies for tuberculosis that are effective even against multidrug-resistant bacterial strains. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

K. Ganesan and Pradip Sen of the Council of Scientific & Industrial Research - Institute of Microbial Technology in India will work to selectively kill cells latently infected with HIV by engineering reagents that would initiate killing only upon specific binding to proviral DNA. If successful, further development could result in a possible cure for latent HIV, which is thought to block the ability of anti-retroviral drugs to fully eradicate the disease. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Sanjiban Banerjee and Sambuddha Ghosh at AbGenics LifeSciences Pvt. Ltd in India will develop a new method to treat intestinal worm (helminth) infections using modified probiotic strains of the bacterium Lactobacillus. Lactobacillus, which can live in the human gut, will be modified to produce stable RNA molecules selected to target specific helminth genes and ultimately destroy the parasite, thereby curing the infection. Because Lactobacillus colonizes the gut, it can be used as a long-term treatment for multiple helminth infections. Efficacy of the approach will be tested in hamster and rabbit models of intestinal worm infections. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Kouichi Hasegawa of the Institute for Stem Cell Biology and Regenerative Medicine in India will develop an assay using human liver cells to study the parasite Plasmodium vivax, which causes malaria, and to screen for new anti-malarial drugs. During the parasitic life cycle inside human hosts, P. vivax infects hepatocytes (liver cells), where it can lie dormant and protected from treatment, leading to disease relapse. To identify new drugs to target this stage of P. vivax requires large numbers of human liver cells, which are difficult to obtain and often unsuitable. A new approach will be used to generate human hepatocytes by isolating a type of white blood cell from individuals infected with P. vivax, and inducing them to differentiate into hepatocytes, which should better support parasite growth. Once validated, this P. vivax liver-stage culture system will be used in a preliminary screen of a set of chemical compounds to identify new anti-malarial drugs. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Debjani Paul, Ninad Mehendale and Ammar Jagirdar from the Indian Institute of Technology Bombay in India will develop a simple system to detect sickle cell disease for use by untrained individuals in tribal populations in India in order to reduce infant mortality rates. Current diagnostics require expensive equipment and trained personnel, and are often inaccessible to the rural populations most in need. They will produce a microfluidic chip that can preserve a sample of blood in the deoxygenated environment required to maintain its characteristic sickle-shape, which can then be detected by a modified mobile phone camera and automated software that they will also develop. The system will be tested for sensitivity and specificity using blood from patients with sickle cell disease. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Saleem Mohammed of XCode is developing a platform for publishing, through which "health signals" will be delivered. These health signals are delivered over a subscriber's mobile phone in a snack format comprised of a reminder system through SMS, a reply mechanism for confirmation, a 1-minute audio clip that educates about the disease, and a quiz for engagement and incentives to be awarded accordingly. The SMS acts as a teaser to the audio clip that expands and goes into greater detail about TB drug adherence. The technology is deployed in the cloud, which enables the solution to scale rapidly and dynamically. REAP TB also uses the services of TB survivors for counseling and following up with TB patients.

Shashank Garg and team will develop a mobile solution that addresses problems in adherence to TB treatment through the key technologies of mobile phone-based electronic forms, workflow management, identity management, and electronic health records. The objective is to achieve automated tracking and monitoring of individual TB patients for adherence to the TB treatment protocol. ASHA workers will use the mobile application for collection of dosage intake data in the field. A workflow system will provide a closed loop through SMS alerts in case a patient defaults. Along with identity management and a TB treatment record, the system will ensure patients are able to seek treatment even on migration, thus maintaining continuity of treatment. This mobile solution is novel because it will use a form-based mobile application capable of running in disconnected or offline mode, with data connectivity being required only for the duration of data upload to the server.

Avin Agarwal and team will develop an electronic pill box with the software architecture based on a client-server software solution with hardware integration. The technique involves tracking the weight of the remaining pills through an electronic pill box with GSM connection and pressure sensor. This approach tracks if the pill is taken out of the pill box for consumption and reports this information to the central server. The solution could be as effective as DOT and a lot cheaper to implement. Addressing the cost of implementation will be emphasized for long-term execution, and an alternate SMS-based solution is suggested to reduce the dependency on pill boxes, in case the objective can be met using a less expensive SMS solution. By the nature of its design, the application will identify defaulters and escalate them for more stringent techniques of monitoring and at the same time alert healthcare professionals only when necessary.

Shweta Roy and team are developing a small, electronic, tablet strip holder that enables real-time tracking of patient treatment adherence and inventory. The tablet strip holder will be small in size, embedded with a weighing scale to monitor change in weight of tablet strips and thereby monitor treatment adherence. Any change in the weight of the strip will be recorded on a server via SMS using a telemetric SIM within the holder. If the change in weight is not detected within a given time period, the device will trigger a non-compliance alert through SMS to the patient and caregiver DOTS observer. The holder will also have an inbuilt alarm to alert the patient in case of missed dosages. The final product will be light weight and sleek in design and the patient will be able carry the tablet strip holder like a mobile phone. Minimal patient input is expected, making this device user friendly, and alerts can be customized as per regional language. The cost of the final device is expected to be $10 - 12 USD per piece.

Nishant Kumar and team are building a mobile hardware app which can serve an electronic pill box and can be attached to a conventional mobile phone. The hardware attachment has a rectangular sleek design, which can be fixed onto the mobile phone or can be used separately. A mobile application runs on the phone and controls the hardware attachment via Bluetooth. This product also facilitates a novel points-based incentives system to further encourage the patient towards continued adherence. A complementary mobile phone application runs on the handheld devices of the health worker. The hardware attachment can either be distributed as a standalone product or with a phone.

Hilmi Quraishi and team are building a system to enable adherence to TB treatment. The proposed solution is sliced from ZMQ's Fully-Technology Linked Model (F-TLM) for TB treatment and management called the Open and Universal Technology based TB (OUT-TB) Management and Treatment Framework. The framework was developed by ZMQ under its Freedom TB initiative. The proposed solution empowers the patients with active compliance reporting, gamification, and effective self-management of TB treatment using mobile-based tools integrated with miniature DOTS Center Systems and DOTS Provider Toolkit. The solution is based on a bottom-up technology model, which empowers patients to take control of treatment with reminder systems, compliance reporting, dosage tracking, test scheduling, and provider connection for need-based supervision. The solution will help in creating networks of treated patients as new knowledge providers, who will serve as peer educators to provide assistive support to patients in their communities. The approach will make the treatment a community-lead model.

Janardan Suresh and team are building a mobile-based application to improve TB adherence. The system, called TB Prasakti, involves SMS-based reminder and follow up, automated telephone reminder and follow up, and a total patient information system, which ensures maximum utilization of technology for TB. It provides for easy scalability and affordability and provides a "single window" to capture, store, remind, follow up and generate reports, thus ensuring a comprehensive and all-encompassing solution. The novelty lies in the solution being a total end-to-end tracking of the TB patient treatment and adherence life cycle, in which all the stakeholders are able to communicate through a single system.

Nakul Pasricha and team are working to develop special cards, called myTBdoc cards, with unique alphanumeric identifiers printed on them to be given to medical representatives (MRs). TB medicines manufactured by Lupin will also have unique identifiers printed on them. MRs will give myTBdoc cards to private doctors that see TB patients, educating them on correct TB prescription methods. Doctors will then give these cards to new TB patients, instructing them to SMS the unique code on the card (enrolling them in our program) and to SMS the unique codes printed on their TB drugs as they take them. PharmaSecure will then deliver phone interventions, such as reminders to take medicines, follow up calls, and TB health tips via SMS and voice calls. Lupin holds a major market share in the Indian TB drug market, and hence the solution will reach out to a larger affected population easily.

Krishna Swamy and team are building a comprehensive tuberculosis (TB) mobile application to improve TB detection, treatment, and adherence. The team will build upon its open-source, mobile health (mHealth) platform CommCare and predeployed CommCare mobile applications for TB in India to develop a comprehensive, SMS-enabled mobile application for TB detection, treatment, and adherence. Dimagi will work with the International Union against Tuberculosis and Lung Diseases, South-East Asia (USEA) in the Khunti District, Jharkhand in India to design, test, evaluate, and scale the proposed mDOTS application, which will be designed around the World Health Organization's recommended directly observed treatment, short-course (DOTS) protocol for TB.

Manjari Deb and team are developing a small, electronic pill dispenser called the CoxBox that enables real-time tracking of patient treatment adherence and inventory. The CoxBox innovation provides a relatively inexpensive and easily implementable solution for action-oriented monitoring and controlling of anti-tubercular drug adherence through the use of a microcontroller-based electromechanical pill box with programmable alarm annunciator and a built-in mobile device.

Bill Thies and the team of 99DOTS aim to achieve 99% TB drug adherence using a combination of basic mobile phones and augmented blister packaging to provide real-time medication monitoring at drastically reduced cost. The approach is to utilize a custom envelope, or blister card, into which each pack of medication is inserted and sealed by the care provider. When the patient dispenses medication from the blister pack, the pills also break through perforated flaps on the blister card. On the back side of each flap is a hidden number. Patients submit these numbers using their mobile phone as evidence that they have dispensed medication. To avoid incurring any mobile charges, the numbers are used to complete a phone number and deliver a "Missed call" (Missed calls are free if they are not pointed to a VoiceMail). Using this system patients also receive a series of daily reminders (via SMS and automated calls). Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counseling. Real-time adherence reports are also made available on the web.

This project aims to utilize ultrasound to move and settle human waste collected in a specifically designed latrine. This redesigned latrine uses less water and therefore provides a more sustainable solution to collect human waste.

Anuradha LeleCentre for Development of Advanced ComputingPune, Maharashtra, India

Grand Challenges India

Tuberculosis Treatment

15 Sep 2014

Anuradha Lele and team from CDAC are building an integrated SMS and voice calling solution, which involves mobile-based applications with forms to register patients, a lab form for sputum examinations, IVRS/missed call reminders, and a patient monitoring application for doctors and DOTS workers. The system also plans to include next of kin and friends to enable seamless monitoring of drug intake of the patient.

This project aims to reduce human Zinc deficiency through biofortification by foliar zinc application. It aims to prove that this traditional and efficient strategy of agronomic biofortification, can be a rapid solution for improving zinc concentration in grain to address the ongoing human zinc deficiency.

Lazar Mathew and team are working on a smart pill box that tracks exactly the time through radio frequency identification (RFID) of the dose coupled with SMS trigger systems. The pill box can dispense blister packs rather than tablets, and incorporates a timer which can only be programmed by the medicine provider. Medication cannot be taken out before or after certain times, preventing double dosage. SMS reminders will be sent to family members as well. Monitoring of up to 90 dosages will be possible with a table-top dispenser.

This project, run in collaboration with international partners Daisa Enterprises (formerly Wholesome Wave) and the McGill University Centre for the Convergence of Health and Economics, aims to pilot an innovative entrepreneurial approach to provide economic benefits and increase agricultural production, nutritional intake, and overall health to women in resource-poor rural and urban communities.

In this ICT-based pilot project, Digital Education, tested the impact of a combination of ICT and Participatory Learning Action (PLA) approaches to improve women's knowledge of nutrition in 30 villages. They promoted the dissemination of a series of nutrition-specific participatory videos to address nutrition-specific behaviors, locally feasible solutions as well as expenditure patterns to improve maternal and child diet quality.

This project aims at refining a biological-agent based technology to understand the optimal conditions needed for its efficient use in India. It aims to use Black Soldier Fly Larvae (BSFL) to consume the human fecal matter and other bodily wastes. The team will test the optimal environmental conditions, in terms of temperature and humidity, for Black Soldier Fly larvae (BSFL) to reduce the amount of human feces in waste septage.

Srikanth Mutnuri from BIRAC in India in collaboration with Willy Verstraete from Ghent University in Belgium, will aim to develop a financially affordable and simple-to-operate decentralized wastewater treatment system for a single household as well as for a gated community of 100 people (25 families) that will produce high quality effluent for safe disposal. The waste treatment system relies on electrochemical reactions and the production of chlorine, to manipulate the pH of the wastewater to destroy pathogens and helminthes.

This is a proof-of-concept development for using viral agents to target and kill pathogens and odor-producing bacteria in fecal waste and also develop for ways to integrate this into waste treatment systems. The potential of this project is immense as, once thoroughly tested; it will provide a completely natural alternate to managing pathogens in waste water.

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